Septoplasty refers to surgical manipulation and/or removal of deviated septal cartilage and/or bone to correct a nasal septal deformity.
Up to 90% of people have nasal septal deviations , but the majority is asymptomatic. Septal deviation may cause nasal obstruction only when the nasal mucosa is swollen due to e.g. inflammation, allergic rhinitis, pharmacologic factors such as rhinitis medicamentosa or hormonal changes during pregnancy; in such cases obstruction may resolve either spontaneously or with medical therapy e.g. intranasal or systemic steroids, antihistamines and decongestants.
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The nasal septum has both bony and cartilaginous components. Anteriorly the septum is composed of the quadrangular cartilage. The posterior septum consists of bone of the perpendicular plate of the ethmoid superiorly and the vomer inferiorly. The most inferior strip of the septum is the maxillary crest, a bony projecttion from the maxilla and palatine bone along the full length of the septum. The maxillary crest articulates with quadrangular cartilage anteriorly and the vomer posteriorly.
What is Septoplasty?
Septoplasty is one of the most frequently operated procedures by rhinologists and facial plastic surgeons. It is performed mainly for reducing nasal obstruction, but it can also provide a better surgical approach in endoscopic sinus and skull base surgery and an easier access for postoperative treatment.
The deviated septum can be cartilaginous, bony, or both. The septum can be curved, tilted, angulated, twisted, present with a formation of spurs, or a combination of these. Therefore, there is no a single “standard” or “routine” operation that can satisfy all variables and complexities of cases.
Septoplasty is a reconstructive procedure tailor-made for individual cases. Understanding the anatomy and a thorough preoperative evaluation of all deviated sites will lead to a better surgical outcome.
Indications for septoplasty:
Septoplasty may be required to correct a deviated nasal septum for
- Irreversible symptomatic nasal obstruction
- Improving access for endoscopic sinus or skull base surgery
- Septal spurs causing epistaxis
Septoplasty must achieve separation of the left and right nasal cavities, adequate nasal air flow, as well as preserve dorsal and tip support of the nose. The authors favour submucosal resection of deviated septal cartilage and/or bone as was first reported and popularized by Freer and Killian.